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141.
Loss of Local Capture of the Pulmonary Vein Myocardium After Antral Isolation: Prevalence and Clinical Significance
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143.
This study was focused on the immunohistochemical profile of the adenomatoid odontogenic tumor. A Pub/Medline search revealed a number of immunohistochemical studies including cytokeratin profiles, extracellular matrix proteins, Integrins, ameloblast‐associated proteins resorption regulators (RANK, RANKL), p53, PCNA, MDM2 protein, cyclin D1, Ki‐67, Bcl‐2 metallothionein, metalloproteinases, D56 hepatocyte growth factor, c‐met, DNA methyltransferase, podoplanin, TGF‐βI, Smad‐2/3, Smad‐I‐5/‐8, Smad 4, beta‐ catenin, calretinin, and clonality. Careful interpretation of the findings indicates that the adenomatoid odontogenic tumor may be more of a hamartomatous than neoplastic nature. 相似文献
144.
145.
Landry CS Grubbs EG Warneke CL Ormond M Chua C Lee JE Perrier ND 《Annals of surgical oncology》2012,19(4):1269-1274
Background
The purpose of this study was to compare the outcome of robot-assisted transaxillary thyroid surgery (RATS) to the standard open technique for thyroid lobectomy in the U.S. population. 相似文献146.
DL Eck SL Koonce RF Goldberg S Bagaria T Gibson SP Bowers SA McLaughlin 《Annals of surgical oncology》2012,19(10):3212-3217
Background
The National Surgical Quality Improvement Program (NSQIP) is a risk-adjusted database designed to benchmark quality initiatives. NSQIP captures uniform morbidity variables for all operations and calculates expected morbidity probabilities. Given the frequent need for reoperation following breast-conserving surgery (BCS) and mastectomy, we hypothesized that NSQIP may inaccurately reflect surgical morbidity after breast cancer operations.Methods
Using the 2008 NSQIP database, we identified 24,447 breast surgery patients. We calculated the observed versus expected (O/E) morbidity ratios, compared them to other general surgery procedures, and analyzed the O/E morbidity ratios among benign and malignant breast diagnoses.Results
The NSQIP database shows that breast surgery has an O/E morbidity ratio of 3.11, which is higher than other general surgery procedures. Additionally, breast operations for malignancy have higher O/E morbidity ratios (3.22) than those performed for benign disease (2.59). Analysis of malignant patients by CPT code revealed that BCS patients had an O/E morbidity ratio of 7.75 and attributed 89?% of morbidity to reoperation, whereas mastectomy patients had an O/E morbidity ratio of only 1.7. Elimination of the reoperation variable from morbidity calculations in breast surgery reduces the O/E morbidity ratio to less than expected in all breast procedures.Discussion
Breast surgery has a higher O/E morbidity ratio than other general surgery procedures. Reoperations are expected in BCS for positive margins and in mastectomy for completion ALND. Breast surgeons should advocate for benchmarking by surgical site-specific metrics, because current NSQIP criteria may negatively affect the quality assessment of high-volume breast centers. 相似文献147.
Comparison of thrombin and ristocetin in the interaction between von Willebrand factor and platelets 总被引:1,自引:0,他引:1
It is known that the antibiotic ristocetin exposes the platelet membrane receptor for factor VIII/von Willebrand glycoprotein (FVIII/vWF). Recent reports suggest that low concentrations of thrombin also cause platelet membrane receptors to become available for FVIII/vWF. As a consequence, the suspicion has been raised that thrombin provides similar or equivalent activity in vivo to that observed for ristocetin under in vitro conditions. In this study, we quantitated the extent to which thrombin promotes the binding of FVII/vWF to platelets and determined whether or not this interaction initiates or complements platelet aggregation. With ristocetin present, the amount of 125I-FVIII/vWF that became platelet-bound correlated closely with the onset, rate, and extent of platelet aggregation. In contrast, at every thrombin concentration tested, the amount of 125I- FVIII/vWF that specifically bound to platelets was about 6% of that observed with ristocetin. Significantly, FVIII/vWF did not augment the rate of aggregation of platelets in response to thrombin or initiate platelet aggregation when subaggregating doses of thrombin were used. These observations indicate that the minimal association that occurs between FVIII/vWF and the platelet membrane in the presence of thrombin does not correlate with platelet aggregation and therefore is not analogous to the effects of ristocetin. Whether the low level of binding relates to another process, such as platelet-endothelial interactions, remains unknown. 相似文献
148.
Pippins JR Gandhi TK Hamann C Ndumele CD Labonville SA Diedrichsen EK Carty MG Karson AS Bhan I Coley CM Liang CL Turchin A McCarthy PC Schnipper JL 《Journal of general internal medicine》2008,23(9):1414-1422
Background Failure to reconcile medications across transitions in care is an important source of potential harm to patients. Little is
known about the predictors of unintentional medication discrepancies and how, when, and where they occur.
Objective To determine the reasons, timing, and predictors of potentially harmful medication discrepancies.
Design Prospective observational study.
Patients Admitted general medical patients.
Measurements Study pharmacists took gold-standard medication histories and compared them with medical teams’ medication histories, admission
and discharge orders. Blinded teams of physicians adjudicated all unexplained discrepancies using a modification of an existing
typology. The main outcome was the number of potentially harmful unintentional medication discrepancies per patient (potential
adverse drug events or PADEs).
Results Among 180 patients, 2066 medication discrepancies were identified, and 257 (12%) were unintentional and had potential for
harm (1.4 per patient). Of these, 186 (72%) were due to errors taking the preadmission medication history, while 68 (26%)
were due to errors reconciling the medication history with discharge orders. Most PADEs occurred at discharge (75%). In multivariable
analyses, low patient understanding of preadmission medications, number of medication changes from preadmission to discharge,
and medication history taken by an intern were associated with PADEs.
Conclusions Unintentional medication discrepancies are common and more often due to errors taking an accurate medication history than
errors reconciling this history with patient orders. Focusing on accurate medication histories, on potential medication errors
at discharge, and on identifying high-risk patients for more intensive interventions may improve medication safety during
and after hospitalization.
Portions of this work were presented as a poster at the 2007 Summer Meeting of the American Society of Health-System Pharmacists,
June 24–27, 2007, San Francisco, CA and as a poster at the 2008 Annual Meeting of the Society of General Internal Medicine,
April 9–12, 2008, Pittsburgh, PA. This study was supported in part by an investigator-initiated grant from the Harvard Risk
Management Foundation, and by internal support from Massachusetts General Hospital, Brigham and Women’s Hospital, and Partners
Healthcare. Dr. Pippins was supported by a National Research Service Award from the Health Resources and Services Administration
(T32 HP11001–18). Dr. Schnipper is supported by a Mentored Clinical Scientist Award from the National Heart, Lung, and Blood
Institute (K08 HL072806). 相似文献
149.
Kaplan LD; Shiramizu B; Herndier B; Hahn J; Meeker TC; Ng V; Volberding PA; McGrath MS 《Blood》1995,85(7):1727-1735
150.
The patterns of cell proliferation and cell migration were studied in three patients with the Sezary syndrome using autoradiographic techniques. Cell labeling patterns following pulse labeling with tritiated thymidine in vivo indicated that Sezary cells proliferate actively in skin and in lymph nodes but that few if any Sezary cells proliferate in the peripheral blood. In two of the patients serial samples were obtained. Label dilution patterns in skin and blood over time suggested that circulating Sezary cells originated in extracutaneous sites where cells were proliferating more rapidly than in the skin. Cells labeled in extracutaneous sites of proliferation appear rapidly in the blood, and their transit time through the peripheral blood compartment is short. Circulating Sezary cells may then be deposited in the skin where they resume proliferation at a low rate. Thus, while Sezary cells proliferate in both cutaneous and extracutaneous sites, proliferation appears to be more rapid in extracutaneous sites such as lymph nodes. This suggests that trials of systemic therapeutic approaches should be undertaken. 相似文献